Provider Demographics
NPI:1134816549
Name:SCROGGINS, KAMRYN BLAIRE
Entity type:Individual
Prefix:
First Name:KAMRYN
Middle Name:BLAIRE
Last Name:SCROGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11604 SHOAL LANDING ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8749
Mailing Address - Country:US
Mailing Address - Phone:832-396-1170
Mailing Address - Fax:
Practice Address - Street 1:2901 RIDGELAKE DR STE 102
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4946
Practice Address - Country:US
Practice Address - Phone:504-354-8078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARBT-23-267232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst